| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $174.90 | $275.00 | $825.04 |
Indiv Phys Supvj Home/Dom/R-Home Mo 15-29 Min
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $174.90 | $275.00 | $825.04 |